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PErineal Assessment and Repair Longitudinal Study (PEARLS): protocol for a matched pair cluster trial.
Debra E Bick1, Christine Kettle, Sue Macdonald
1King's College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, UK. debra.bick@kcl.ac.uk
BMC Pregnancy and Childbirth
|February 27, 2010
Summary
A new training program for perineal care can significantly reduce pain and improve recovery for women after childbirth. This initiative aims to standardize practices and enhance clinician skills for better maternal health outcomes globally.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Clinical Quality Improvement
Background:
- Perineal trauma affects approximately 85% of women experiencing vaginal birth in the UK annually, with millions affected worldwide.
- Current evidence supports continuous suturing techniques over interrupted methods for reducing pain and postnatal morbidity, yet their adoption remains limited.
- Significant variability exists in perineal suturing skills and postnatal trauma management among maternity units, necessitating standardized training.
Purpose of the Study:
- To evaluate the effectiveness of a standardized, multi-professional training package for perineal assessment and repair.
- To improve the management of perineal trauma and reduce associated postnatal morbidity in women.
- To enhance midwifery and obstetric skills in perineal care through a cascading training model.
Main Methods:
- A matched pair cluster trial (Perineal Assessment and Repair Longitudinal Study - PEARLS) conducted in UK maternity units.
- Randomized implementation of the training intervention (early or late) within matched pairs of units.
- Recruitment of women with episiotomy or second-degree perineal tears, with outcomes assessed at 10 days and three months post-birth.
Main Results:
- Preliminary work involved Delphi surveys and consensus conferences to identify patient-important outcomes.
- Outcomes assessed include women's experiences of perineal pain, pain during activity, breastfeeding rates, and psychological well-being (using the Edinburgh Postnatal Depression Scale).
Conclusions:
- Implementing evidence-based perineal assessment and management practices can lead to substantial improvements in women's physical and psychological health.
- Standardized training holds the potential to reduce perineal pain and postnatal morbidity for a significant number of women globally.
- The PEARLS initiative aims to address the variability in care and promote best practices in perineal trauma management.
